15 May,2021 05:11 AM IST | Mumbai | Vinod Kumar Menon
Dr Indrajit Khandekar has set off another debate over his stand to check patients without the PPE kit
Allow relatives to be with Covid-19 patients. This central health ministry guideline has been overlooked in Maharashtra resulting in scores of victims of the virus being forced to put up a lonely fight, a doctor from Sevagram has said. Dr Indrajit Khandekar, a professor of Forensic Medicine at MGIMS, went a step ahead by not wearing the PPE kit to ensure a human touch with Covid-19 patients.
Most hospitals keep the kin away from patients citing government norms. "This is inhuman and cruel," said Dr Khandekar, pitching for making interaction of relatives with patients and medical staff a part of treatment protocols. "Interacting with relatives can be extremely therapeutic and can give a patient the desire to survive in the most difficult situations," he said.
Dr Khandekar headed a Covid-19 unit of Kasturba hospital, attached to MGIMS, between April 17 and May 3. He treated about 90 patients with just an N95 mask.
Loneliness can make even non-serious patients lose hope and refuse treatment, particularly those struggling to manage chores like using the washroom, eating and drinking. "Some disoriented patients remove oxygen masks and urinate on the floor. Such patients need continuous help and it's not possible for any healthcare worker to provide that," he said.
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Language can also be a barrier, said Dr Khandekar, adding the Centre's guidelines clearly talk of all these aspects.
"When a Covid-19 patient dies, it is impossible to resolve the doubts of the family members. It is ruthless not to give relatives a chance to say goodbye to them while they are still alive," said Dr Khandekar. He added, "PPE lowers my confidence and I can't do the job assigned to me properly. That doesn't mean I'm careless."
However, not all experts agree with Dr Khandekar.
Dr Santosh Bansode, Head of the Department of Emergency Medicine at Wockhardt Hospital, Mumbai Central, said the guidelines are clear about who can manage without a PPE kit. "Anyone coming in direct contact with patients should wear full PPE and not just an N95 mask and gloves. They include Isolation centres' holding area and triage staff." He said since doctors in chambers need to examine patients, they must wear the gears. "Even after wearing full PPE, sometimes doctors and healthcare workers get infected. Why take a chance," said Dr Bansode.
On the allowing relatives, Dr Bansode said, "I have read the guidelines point by point and I am of the belief that no visitors or attendants should be allowed with admitted Covid-19 patients. I understand that patients with Covid-19 need emotional support but that can be given with frequent video calls by relatives to patients." He said that since most patients get discharged after five days, it's better not to expose relatives to the hospital environment. "Currently we are facing a second wave so we must not take any risk."
Dr Rajesh Dhere, dean of BKC Covid-19 centre and also the head of Forensic Medicine and Toxicology at Sion hospital, said, "It is highly risky to examine patients in Covid-19 wards without PPE kits and other mandatory gears because the virus can get fixed to clothes and even skin. Knowingly or unknowingly the said doctor can get infected and spread the virus."
Dr Dere agreed that the presence of relatives can make a positive change for patients. "But no one can be sure about how a patient would react after spotting his loved one next to him. The chances of emotional outburst cannot be ruled out, and it can affect other patients too."
According to psychotherapist Dr. Shivangi Pawar, it is not possible for the hospital staff to calm down every patient and a family member could accelerate healing. "However, it must be assured that adequate safety precautions are taken by the hospital and the visitor. Adopting strict protocols might prevent undesired disputes between hospitals and visitors," she said.
Dr Subhash Hira, Professor of Global Health at the University of Washington-Seattle, the Centre's norms also allow hospitals to provide services as per available resources and needs. He talked of some states letting relatives be with patients with protective gears and a clear understanding of the risk of transmission and its consequences to them and the community. "However, this arrangement compromises the principles of barrier-nursing required for a respiratory infectious disease and therefore, other states have engaged psychologists to fill up the needs of counseling. It is a trade-off between demand and supply of services."
Dr Hira added, "It is highly desirable to capture experience of personal care by relatives, yet ensuring protection from transmission as we prepare for a third wave sometime in August-September."
Dr T P Lahane, Director of Directorate of Medical Education and Research and the nodal officer in charge of state's Covid-19 task force, said, "A forensic surgeon can do clinical patient care, but he needs to wear PPE kits and other safety gears before entering Covid-19 wards as the doctor may get infected and become a carrier."
On relatives in Covid-19 wards, Dr Lahane said, "Relatives with Covid-19 patients can speed up recovery, but chances of the relative getting infected is also high. Hence we do not allow relatives to visit Covid-19 patients."
